November 17, 2017

Here’s what to know before asking your pediatrician for an antibiotic.


It’s cold and flu season. Your child is sneezing, coughing and miserable. Should you ask for an antibiotic?

“It’s tempting to prescribe or take antibiotics for a cold virus, for example. But we need to spread the word that antibiotics aren’t active against viruses and could actually be causing harm,” said Ritu Banerjee, M.D., Ph.D., medical director of Antimicrobial Stewardship at Monroe Carell Jr. Children’s Hospital at Vanderbilt.

It’s important for parents to know when kids need antibiotics and why sometimes the pediatrician won’t prescribe them.

Question: What is antibiotics resistance and why should people care?
Answer: Antibiotic resistance occurs when bacteria become resistant or harder to kill with our typical antibiotics. This happens because the more bacteria are exposed to antibiotics, the craftier they become. They have all sorts of genetic changes that make them harder to kill with our everyday antibiotics. And this means it’s harder to cure infections, and it leads to worse outcomes for our patients.

Question: What are superbugs?
Answer: There are some strains of bacteria that are not killed by any of our available antibiotics. These are superbugs, and they’ve led to some really horrific infections that have been fatal. There are probably many more infections caused by antibiotic-resistant bacteria than we even record.

Question: It’s estimated that about half of the antibiotic prescriptions prescribed in the U.S. are inappropriate. What does that mean?
Answer: That’s exactly right. That’s data from the U.S. Centers for Disease Control, and that means that half of our prescriptions, our antibiotic prescriptions, are actually for the wrong drug, given at the wrong dose or the wrong length of time, or given for viral infections or other illnesses that are not treatable by antibiotics. It’s estimated that nearly 80 million antibiotic prescriptions in this country are unnecessary.

Question: If your child’s pediatrician says, “This illness is a virus. I cannot give you an antibiotic,” then these are wise words?
Answer: Absolutely. It’s important to remember that most sore throats, coughs, congestion, ear infections and sinus infections are actually caused by viruses and not bacteria. Most of the time, children and adults will recover from these viral infections without any antibiotics.

Question: What should you do if the illness continues for a long time?
Answer: Sometimes infections that start off as viral infections become bacterial infections. That distinction — bacteria versus virus — should really be made by a clinician who’s examining the patient. When an infection, like the common cold or a sinus infection, just first starts out, it’s usually a viral infection and it does not need antibiotics from the onset.

Question: Can you explain the process of becoming resistant?
Answer: It’s important to understand a person doesn’t become antibiotic resistant. Bacteria become antibiotic resistant. We have millions and millions of bacteria on our skin and in our intestines, and all throughout our body. And the more we are exposed to antibiotics, the more these bacteria become smart and crafty and figure out ways to get around these antibiotics. So, they become resistant. Another way people get antibiotic-resistant bacteria is through being in contact with another person or an infected surface, where resistant bacteria are hanging out. That’s why it’s really important to wash our hands, especially during cold and flu season. Because not just bacteria, but also viruses, are transmitted person to person and through contact with other infected people and surfaces.

Question: Some pediatricians recommend changing your children out of their clothes when they come home from school during cold and flu season because of all the germs that are clinging onto their clothes during the day. Is this a good idea?
Answer: Yes. That’s a great piece of advice. And in fact, when I come home from work at the end of the day, the first thing I do is change out of my work clothes.

Question: Why is it important for us to take antibiotics as they are prescribed?
Answer: It’s very important to take antibiotics that are prescribed for you and you only. Never take antibiotics that are left over from a prior infection or a prior prescription, or that were prescribed for your child rather than for yourself. Doses are individualized and you might be getting either too high, or too low a dose if you take medicines that are prescribed for someone else. Also antibiotics expire. They have shelf lives, and if you use leftover antibiotics, you’re not necessarily getting the right dose into your body. If you have a suboptimal dose, then that helps bacteria become resistant to these drugs.

Question: Does green-colored mucus always mean you need an antibiotic?
Answer: No. You cannot tell if something is viral or bacterial based on the color of your mucus or snot.

Question: What else do we need to know about using antibiotics more wisely?
Answer: Antibiotics are life-saving medications. They’ve really transformed modern medicine, but we need to use them wisely or else they lose their effectiveness. We should think of them as a limited resource the same way we think of our natural resources, so we need to conserve them. That means use them only when they’re needed, to treat bacterial infections, but not treat viral infections. It’s important to remember most of our common cold and flu symptoms are caused by viruses, not bacteria. So, when you are at the doctor for your child or for yourself, ask if you need an antibiotic and what infection are you being treated for with this antibiotic.

Also, healthcare providers really need to be judicious about prescribing antibiotics and remember to use them only for bacterial infections and not for viral infections. Most institutions nowadays have antibiotic stewardship programs, which are systems to help clinicians follow clinical guidelines and use antibiotics appropriately. Those are things that both, healthcare providers and patients, can do. And lastly, it’s very important everybody wash their hands and get the recommended vaccines, such as the annual flu shot, to prevent infections during the cold and flu season.






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Vanderbilt’s Children’s After-Hours Clinics offer the convenience of a walk-in clinic with care provided by a board-certified pediatrician from Children’s Hospital. No appointment is necessary, but we recommend calling your pediatrician first. Learn more about services and find locations for Children’s Hospital After Hours Clinic locations.